Irregular fatty infiltration of the liver: diagnostic dilemmas

Five cases in which fatty infiltration of the liver occurred in a nonuniform distribution involving predominantly the right lobe of the liver are reported. Such nonuniform fat deposition may cause serious difficulty in the interpretation of the sonographic examination. With extensive hepatic fat deposition, the natural tendency of the operator to adjust the sonographic equipment to display most of the liver as a uniform medium gray tone resulted in the display of the small, normal areas of the liver as apparently abnormal anechoic areas. CT correctly identified the fat-infiltrated areas. Confusion between metastases and fat deposition on this basis can be anticipated in future patients.